Healthcare Provider Details

I. General information

NPI: 1851589709
Provider Name (Legal Business Name): MOHIT ALEX DEWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BIELENBERG DR STE 220
WOODBURY MN
55125-2625
US

IV. Provider business mailing address

635 BIELENBERG DR STE 220
WOODBURY MN
55125-2625
US

V. Phone/Fax

Practice location:
  • Phone: 651-998-9048
  • Fax:
Mailing address:
  • Phone: 651-998-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number53792
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number53792
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: